Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207K00000X | Allergist & Immunologist | 15260 | NE |
NPI | 1093707754 |
---|---|
Provider Name | Mr. Roger Hiro Kobayashi |
First Address | Omaha, NE 68124-3253 |
Second Address | Omaha, NE 68124-3253 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 18/08/2005 |
Last Update Date | 30/06/2011 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
47060801514 | (05) | NE |
B67808 | (02) |